Healthcare Provider Details

I. General information

NPI: 1194724476
Provider Name (Legal Business Name): TAMARA MARIE GREEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA GREEN MD

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11810 W MARKET PL STE 300
FULTON MD
20759-2711
US

IV. Provider business mailing address

244 MADISON AVE # 149
NEW YORK NY
10016-2817
US

V. Phone/Fax

Practice location:
  • Phone: 301-900-6334
  • Fax: 301-859-4620
Mailing address:
  • Phone: 301-900-6334
  • Fax: 301-859-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0094786
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: